Healthcare Provider Details

I. General information

NPI: 1326190323
Provider Name (Legal Business Name): PACER HEALTH MANAGEMENT CORPORATION OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HOSPITAL DR
BARBOURVILLE KY
40906-7363
US

IV. Provider business mailing address

80 HOSPITAL DR
BARBOURVILLE KY
40906-7363
US

V. Phone/Fax

Practice location:
  • Phone: 606-545-5500
  • Fax: 606-545-5511
Mailing address:
  • Phone: 606-545-5500
  • Fax: 606-545-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100721
License Number StateKY

VIII. Authorized Official

Name: MRS. REBECCA A LEWIS
Title or Position: CEO
Credential:
Phone: 606-545-5521